Nursing 612 Exam 3
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Free Nursing 612 Exam 3 Questions
Mr. Borden is 79 years old and lives with his daughter. The daughter provides excellent care for her father and wants to know which changes in his heart and circulatory system are due to aging and which are due to lifestyle choices. The nurse practitioner replies:
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The size of the heart increases with age.
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The activity of the heart decreases in its ability to deal with stress, as well as to provide physical strength as one ages.
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The left ventricle hypertrophies in response to increasing in age.
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The patient’s diet affects the ability of the heart to balance blood pressure.
Explanation
The Correct Answer is:
B. The activity of the heart decreases in its ability to deal with stress, as well as to provide physical strength as one ages.
Detailed Explanation:
With normal aging, the cardiac reserve—the heart’s ability to increase output during stress, illness, or physical exertion—declines. This occurs due to decreased myocardial contractility, reduced responsiveness to catecholamines, and increased stiffness of the myocardium and arteries. As a result, older adults experience reduced tolerance for activity and slower recovery from physical or emotional stress. This diminished function is a natural part of aging, not necessarily caused by poor health habits.
The nurse practitioner sees a patient in the emergency department with reports of chest pain and nausea. To analyze the patient’s condition, what further information is needed?
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Whether there has been constipation.
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Information regarding last food intake.
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Information regarding urinary difficulties.
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A description of the pain.
Explanation
The Correct Answer is:
D. A description of the pain.
Detailed Explanation:
When a patient presents with chest pain and nausea, obtaining a detailed description of the pain is essential for determining whether it is cardiac in origin. The nurse practitioner should assess the location, quality, duration, intensity, radiation, and precipitating or relieving factors of the pain. This helps differentiate cardiac ischemia (e.g., angina or myocardial infarction) from gastrointestinal, musculoskeletal, or pulmonary causes. While food intake or bowel/urinary issues may provide supporting clues, the pain characteristics are the most critical diagnostic component for immediate assessment and intervention.
In treating AAA, arterial monitoring is recommended. Which of the following IV antihypertensive agents should be used to rapidly and consistently maintain blood pressure in the mean arterial pressure ranges? Select all that apply.
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Esmolol
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Carbidopa
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Nitroglycerin
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Nicardipine
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Sertraline
Explanation
The Correct Answers are:
A. Esmolol and D. Nicardipine.
Detailed Explanations:
A. Esmolol:
Esmolol is a short-acting beta-blocker that provides rapid and precise blood pressure control. It is particularly useful in patients with aortic aneurysm because it reduces heart rate and myocardial contractility, lowering shear stress on the aortic wall and minimizing the risk of rupture.
D. Nicardipine:
Nicardipine is a calcium channel blocker administered intravenously for smooth, titratable control of hypertension. It effectively lowers blood pressure without compromising organ perfusion, making it ideal for managing blood pressure in acute aortic conditions such as an abdominal aortic aneurysm (AAA).
A patient comes to the health-care provider office for a checkup. The nurse practitioner notes that the patient is 67 years old and is presenting symptoms of dizziness, orthopnea, and edema. The nurse practitioner begins a focused assessment of the:
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Neurological system
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Reproductive system.
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Respiratory system.
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Cardiovascular system.
Explanation
The Correct Answer is:
D. Cardiovascular system.
Detailed Explanation:
The symptoms of dizziness, orthopnea (shortness of breath when lying flat), and edema are hallmark indicators of cardiovascular dysfunction, particularly heart failure or impaired cardiac output. These symptoms reflect decreased efficiency of the heart to pump blood effectively, leading to fluid accumulation and reduced perfusion. A focused cardiovascular assessment—including inspection for jugular venous distention, auscultation for abnormal heart sounds, assessment of peripheral pulses, and evaluation for dependent edema—is essential for diagnosis and management. While respiratory issues may coexist, the root cause is most likely cardiac.
The nurse practitioner implements an approved plan of care proposed in the National Asthma Education and Prevention Program Expert Panel Report-3 (NAEPP-EPR-3) for an older adult patient with asthma. This includes which of the following? Select all that apply.
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Monitoring of appropriate use of medications.
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Patient, family, and professional education so as to create a partnership in asthma management.
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Control of comorbidities.
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Use of a standardized asthma care plan
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Completion of the assessment and monitoring, as this is not an ongoing process.
Explanation
The Correct Answers are:
A. Monitoring of appropriate use of medications, B. Patient, family, and professional education so as to create a partnership in asthma management, C. Control of comorbidities, and D. Use of a standardized asthma care plan.
Detailed Explanations:
A. Monitoring of appropriate use of medications:
Regular monitoring ensures proper use of both controller and rescue medications, promoting adherence and preventing overuse or underuse that could worsen symptoms or cause side effects.
B. Patient, family, and professional education so as to create a partnership in asthma management:
The NAEPP emphasizes a collaborative approach involving patients, families, and healthcare providers. Education enhances understanding of triggers, medications, and self-management techniques.
C. Control of comorbidities:
Managing related conditions such as allergic rhinitis, GERD, and obesity improves asthma control and reduces exacerbations.
D. Use of a standardized asthma care plan:
A written, evidence-based asthma action plan guides daily management and provides instructions for handling worsening symptoms or attacks.
The nurse practitioner knows that risk factors for coronary artery disease (CAD) include atherosclerosis. The nurse practitioner includes teaching on these factors that can be remediated to help prevent CAD:
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Age
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Advanced age and male gender.
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Cholesterol levels and smoking.
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Low blood pressure.
Explanation
The Correct Answer is:
C. Cholesterol levels and smoking.
Detailed Explanation:
Atherosclerosis is a primary contributor to coronary artery disease (CAD), and modifiable risk factors play a major role in its prevention. Elevated cholesterol levels lead to plaque buildup in arterial walls, while smoking accelerates endothelial damage, promotes vasoconstriction, and increases platelet aggregation—all of which heighten CAD risk. These factors can be improved through lifestyle changes, diet, and medication.
Anne is a 50-year-old post-mastectomy patient diagnosed with secondary lymphedema. Based on her surgical history, which of the following may be the contributing factor to the lymphedema?
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Urological cancer
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Infection
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Breast cancer
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Gynecological cancer
Explanation
The Correct Answer is:
C. Breast cancer.
Detailed Explanation:
Secondary lymphedema commonly develops after breast cancer surgery, especially when lymph nodes are removed or damaged during a mastectomy or radiation therapy. Disruption of lymphatic drainage in the arm on the affected side leads to fluid accumulation, swelling, and tissue fibrosis. This is a frequent complication of axillary lymph node dissection. In contrast, urological and gynecological cancers (A and D) may cause lymphedema in the lower extremities, while infection (B) is more often a consequence rather than the primary cause in this context.
Lymphedema is characterized by swelling of the extremity. Which of the following symptoms are also presented with lymphedema? Select all that apply.
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Overall lethargy
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Restricted range of motion
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Aching in the affected area
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Cellulitis
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Purulence
Explanation
The Correct Answers are:
B. Restricted range of motion, C. Aching in the affected area, and D. Cellulitis.
B. Restricted range of motion:
As lymphedema progresses, the affected limb becomes heavy, tight, and firm due to fluid buildup and tissue fibrosis. This leads to reduced flexibility and difficulty moving the joint near the swollen area. Over time, chronic swelling can limit function and interfere with daily activities such as walking, dressing, or reaching.
C. Aching in the affected area:
The accumulation of lymph fluid increases pressure within the tissues, resulting in a sensation of aching, heaviness, or discomfort. This pain is typically dull rather than sharp and worsens with prolonged standing, sitting, or lack of limb elevation. The aching is a hallmark symptom reflecting the strain caused by persistent lymphatic congestion.
D. Cellulitis:
Lymphedema compromises local immune defense, making the affected area prone to bacterial infections such as cellulitis. Even minor skin breaks can allow bacteria to enter and multiply within the stagnant lymph fluid. Signs of cellulitis include warmth, redness, tenderness, and sometimes fever, requiring prompt antibiotic treatment to prevent worsening or recurrence.
The nurse practitioner is preparing discharge instructions for a 79-year-old man with newly diagnosed asthma. Which of the following are important instructions to include? Select all that apply.
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There is no need to follow up with your doctor unless your symptoms get worse.
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As you get older, you are more likely to experience difficulty breathing.
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Symptoms of asthma may include a runny nose or postnasal drip
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Experiencing strong emotions like anger can trigger an asthma episode.
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Infections can lead to an occurrence of asthma.
Explanation
The Correct Answers are:
B. As you get older, you are more likely to experience difficulty breathing, C. Symptoms of asthma may include a runny nose or postnasal drip, D. Experiencing strong emotions like anger can trigger an asthma episode, and E. Infections can lead to an occurrence of asthma.
B. As you get older, you are more likely to experience difficulty breathing:
Older adults experience age-related changes in lung elasticity and chest wall compliance, which can worsen asthma symptoms and reduce lung function. This makes proper asthma control and regular monitoring essential to prevent complications.
C. Symptoms of asthma may include a runny nose or postnasal drip:
Upper airway symptoms, such as nasal congestion or postnasal drip, are often associated with asthma and may act as triggers. Managing these symptoms through allergy control and nasal treatments can help prevent asthma flare-ups.
D. Experiencing strong emotions like anger can trigger an asthma episode:
Emotional stress and strong feelings, such as anger, anxiety, or fear, can cause rapid breathing and airway tightening, leading to bronchospasm. Patients should learn relaxation techniques and stress management strategies to reduce this trigger.
E. Infections can lead to an occurrence of asthma:
Respiratory infections, especially viral ones like the common cold or flu, are major triggers for asthma exacerbations. Patients should be advised to practice good hygiene, stay current with vaccinations, and seek early treatment for respiratory illnesses.
Ms. Alma, 69 years old, seeks medical advice because she is having trouble breathing. She is experiencing dyspnea, chronic cough with sputum production, and decreased activity tolerance. The nurse practitioner suggests which of the following? Select all that apply.
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The body contains less water as you age, and the mucus begins to dry out.
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As you get older, the tissue in your lungs is not as flexible to aid in exhaling.
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The muscles that help to inhale become stronger as you age.
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The cough reflex is normal, but the mucus is too thick.
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As you get older, there is an increase in the exchange of gases between the lungs and the blood vessels.
Explanation
The Correct Answers are:
A. The body contains less water as you age, and the mucus begins to dry out; B. As you get older, the tissue in your lungs is not as flexible to aid in exhaling; and D. The cough reflex is normal, but the mucus is too thick.
Detailed Explanations:
A. The body contains less water as you age, and the mucus begins to dry out:
With aging, total body water decreases, leading to thicker mucus that is harder to expel. This contributes to chronic cough and ineffective airway clearance.
B. As you get older, the tissue in your lungs is not as flexible to aid in exhaling:
Elastic tissue in the lungs loses its flexibility with age, causing reduced recoil and air trapping. This makes it harder to exhale completely and leads to shortness of breath.
D. The cough reflex is normal, but the mucus is too thick:
Although the cough reflex remains intact, thicker mucus is more difficult to clear, reducing the effectiveness of coughing and increasing the risk of airway obstruction or infection.
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